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General NPI Number Information
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NPI Number | 1295119881
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Entity Type | Individual
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Provider Name | KIMBERLY AVALLONE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | PO BOX 15
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City | ROSS
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State | OH
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Zip | 45061-0015
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Country | US
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Telephone | 734-249-8241
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 15
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City | ROSS
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State | OH
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Zip | 45061-0015
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Country | US
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Telephone | 734-249-8241
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301016120
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | P.08624
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License Number State | OH
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